The Application of Scrotoscope-Assisted Minimally Invasive Excision for Epididymal Mass: An Initial Report

Abstract

Background: To compare the middle-term efficacy and safety results between scrotoscope-assisted (SA) minimally invasive excision and traditional open excision (OE) for the treatment of epididymal mass.

Methods: A total of 253 males with surgery excision of epididymal mass from 2012 to 2018 were included in this retrospective study. Patients were divided into two groups: the traditional OE group and the SA group. Patient demographics and intraoperative and postoperative outcomes were obtained and compared between these two groups.

Results: About 174 patients (68.8%) underwent SA, and the other 79 (31.2%) underwent OE. Demographic data were similar between the two groups. Compared with OE surgery, SA could significantly shorten the operating time (19.4 ± 4.1 vs. 53.8 ± 12.9 min), reduce blood loss (5.3 ± 1.5 vs. 21.3 ± 5.6 ml), and downsize the operative incision (1.5 ± 0.3 vs. 4.5 ± 0.8 cm). Additionally, postoperative complications were significantly less occurred in the SA group than those in OE (15.5% vs. 21.5%), in particular scrotal hematoma (1.7% vs. 12.7%) and incision discomfort (2.8% vs. 6.3%). Patients in the SA group had a significantly higher overall satisfaction score (94.8 ± 3.7 vs. 91.7 ± 4.9) and a significantly shorter length of hospital stay (4.1 ± 0.9 vs. 5.0 ± 1.5 days) than those in the OE group. No postoperative testicular atrophy occurred in the SA group.

Conclusion: SA is emerging as a novel and effective option with promising perspectives for epididymal mass therapy.

Keywords: epididymal mass; minimally invasive; open excision; scrotal disease; scrotoscope.

Figure 1

Main surgical procedures of scrotoscope-assisted epididymal mass (EM) excision. (a) A 1.0-cm incision is established on the affected side of the scrotum, then two Allis forceps hold the whole scrotal wall. (b) The scrotoscope is put into the tunica sac, and the scrotal contents were inspected sequentially. (c) The location, appearance, size, and margin of the EM are mainly observed. (d) Electrosurgical excision of the EM by plasma electroresection is performed. (e) The wound gets electrocoagulation to stop bleeding. (f) The resected fragments of mass are retrieved. (g) A drainage strip is placed into the scrotum. (h) The resected fragments of mass are sent for pathological examination.

Figure 2

Intraoperative and postoperative data. Scrotoscope-assisted (SA) excision showed less operating time, less blood loss, shorter length of incision, and less frequency of dressing changes. SA presents no significant advantage in the number of hospital stays. Furthermore, compared to open excision, SA also leads to a higher score in satisfaction (all p-value < 0.05). (a) Operating time. (b) Hemoglobin reduction. (c) Incision size. (d) Frequency of dressing changes. (e) Hospital stay. (f) Satisfaction score.